Prostate cancer is the abnormal growth of cells in the prostate gland . Localized prostate cancer has not spread outside the gland. Early prostate cancer usually doesn't cause symptoms.

Prostate cancer is the most common cancer in men. Most men who get it are older than 65. If your father, brother, or son has had prostate cancer, your risk is higher than average.

African-American men have higher rates of both prostate cancer and deaths from it.

About 17 out of 100 men living in the United States will get prostate cancer. Out of these 17 men, 3 will die of prostate cancer. This means that 97 out of 100 men will die from something other than prostate cancer.¹

Unlike many other cancers, prostate cancer is usually slow-growing. When prostate cancer is found early—before it has spread outside the gland—it may be cured with radiation or surgery.

Prostate cancer that has grown beyond the prostate is called advanced prostate cancer. Treatment choices are different for that stage of cancer.

• Surgery takes out the prostate and any nearby tissue that may contain cancer, including lymph nodes. This surgery is called a radical prostatectomy (say "pros-tuh-TEK-tuh-mee"). A doctor can do it as open surgery by making a cut, or incision, in your belly or groin. Or he or she can do laparoscopic surgery by putting a lighted tube, or scope, and other surgical tools through much smaller cuts in your belly or groin. The doctor is able to see your prostate and other organs with the scope. Some doctors may do robot-assisted surgery. The surgeon controls the robotic arms that hold the tools and scope.
• Radiation uses X-rays and other types of radiation to kill the cancer cells. This may be done with:
  • External-beam radiation, in which a machine aims high-energy rays at the cancer.
  • Brachytherapy (say "bray-kee-THAIR-uh-pee"), in which tiny pellets of radioactive material are injected into or near the cancer.
  • Both kinds of radiation.

For many men, radiation and surgery work about equally well to treat localized prostate cancer. Both also have risks, such as loss of bladder control and erection problems.

One treatment may be better for you than the other because of your age, your other health problems, and how you feel about each treatment. You and your doctor can talk about your situation.

Men who are younger than 70 and in good health can usually have either treatment. But if you're age 70 or older, you should consider any other health problems that you have, such as heart disease. They could make surgery too risky.

Follow-up treatment

After either treatment, you will need regular checkups. You will probably have:

• Physical exams.
• Prostate-specific antigen (PSA) tests.
• Digital rectal exams.
• Biopsies if needed.

You may have surgery if:

• You are in good general health and expect to live at least 10 more years.
• It looks like all the cancer can be removed.
• You don't have other health problems that add to the risks of major surgery.

This surgery usually works well to treat cancer that has not spread beyond the prostate gland. Studies following men for 20 years after surgery for localized prostate cancer showed that over 90 out of 100 men died of something other than prostate cancer. This means that less than 10 out of 100 men who had surgery died of prostate cancer.²

Some specially trained surgeons in large medical centers do robotic-assisted laparoscopic surgery. The surgeon controls robotic arms that hold the tools and scope. The rate of problems after laparoscopic surgery is about the same as open surgery.

Studies show that how well you come through the surgery and the extent of your side effects depend more on the skill of your surgeon than on the kind of surgery you have.¹

Radiation may be used:

• Alone or along with hormone therapy.
• Along with surgery. This is rarely done.
• When you have other health problems that make surgery too risky.

Radiation and surgery seem to work equally well for localized prostate cancer. But radiation might not be used in younger men because of concerns that the prostate is still there and could get cancer again.

A radical prostatectomy has all the risks of any major surgery, including:

• Heart attack.
• A blockage of blood flow in an artery in the lung (pulmonary embolism).
• Bleeding.
• Infection.
• Reactions to anesthesia or other medicines.

Prostatectomy also may cause bladder problems and erection problems. More and more often, this surgery is being done in a way that saves the nerves that control erections.

• Erection problems: How much surgery affects a man's erections depends on his age, his sexual function before his surgery, and the location of his tumor. About half of the men who have nerve-sparing surgery regain most of their sexual function.³
• Bladder problems: Bladder problems range from needing to wear pads to dribbling urine now and then during stressful activities. Bladder problems after surgery tend to get better as time goes on.

Surgery also can cause scar tissue that may narrow the outlet to your bladder. Or your rectum or ureters could be injured.

Studies show that men have fewer side effects when this surgery is done by a doctor who has done it many times.⁴

About half of men who have external radiation have erection problems within 5 years of treatment.⁵ Erection problems after radiation therapy tend to get worse over time.⁶

Most other side effects generally go away after treatment. But in some cases they may last. Other side effects include:³

• An irritated rectum and an urgent need to pass a stool.
• An inflamed bladder and trouble urinating.
• An inflamed intestine and diarrhea.
• Trouble controlling urine.
• Pain when you urinate.

Your doctor might advise you to have surgery if:

• Surgery can remove all of the cancer.
• You are young and want to do all you can to make sure that the cancer doesn't come back.
• You don't have other health problems that would add to the risks of major surgery.

Your doctor might advise you to have radiation if:

• You have health problems that make surgery too risky.
• You already have bladder, bowel, or erection problems.